Inscriptions

ESSENTIAL TO CONFIRM ATTENDANCE
The purpose of this form is to formalize the registration for the conference. Your data will be used solely and exclusively for the management of your registration and the processing of the diploma.

Registration form

Please fill in the form with your data

Name and surname

Phone

Department

Hospital

Observations

I have read and agree privacy policy

The person, in attending the day or course, may be filmed and photographed by the organization, and these graphic and / or audiovisual media may be used by the entity for the sole purpose of promoting said day or course. In case the assistant wishes to withdraw his authorization to the organization of the day or course, he can do so by writing a written document, in a reliable way to the e-mail: comunicacio@mutuaterrassa.cat or to the postal address Carrer de Sant Antoni, 32 - 08221 Terrassa